[What does the established physician expect from the West German health system? Fee reduction and drug control as a consequence of economic assessment. What can be done?].
We have briefly tried to inform about the fact why controls of profitableness have to be carried out, how is their course and by virtue of which standards the unprofitableness is assessed. In form of a randomized summary we will once more specify what the physician by all means should do if the fee is reduced or a drug recourse takes place: 1. The date of receipt is to be written clearly visible on the control rescript, since this is of importance for the grace when legal remedies may be applied. 2. Test the rescript, whether or not the reducing or the recourse seems to be justified or whether you have the impression that the data of your activity and management of your practice have not been fully taken into consideration. In this case you at once object and announce a detailed argument. 3. Test quietly, after the first irritation has subsided, whether the points of view explained in the paragraphs 3 and 4 have been taken into consideration, in particular: a. Is the comparative group right? b. Is the present elevation of the average values suited to justify the reducing measure performed? c. Are all peculiarities of the practice taken into consideration? d. Are the peculiarities of the practice sufficiently exactly quantified? e. Was a possible compensatory less expenditure taken into consideration? 4. Summarize the result of your own inquires, as they are described in item 3, in a relevant argument as short as possible. If you need statistical data, which are not at your disposal, for writing this argument, so request such data from the control department of your health-insurance company. 5. In a drug recourse you control, whether or not you can acknowledge the judgment of the arguments for reducing declared. Otherwise you request from your health insurance company the examination into the adequate prescriptions, in which case you probably have to go into the business premises of your health insurance company, in order to be able to take notes there.(ABSTRACT TRUNCATED AT 250 WORDS)
Broglie
M G
MG
D003363:Cost Control / Q000639:trends; D005251:Fees, Medical / Q000639:trends*; D005252:Fees, Pharmaceutical / Q000639:trends*; D005858:Germany; D006801:Humans; D011057:Politics; D011216:Practice Management, Medical / Q000191:economics*; D012943:Social Security / Q000191:economics*
Was erwartet einen niedergelassenen Arzt im westdeutschen Kassensystem? Honorarkürzung und Arzneimittelregress als Folge der Wirtschaftlichkeitsprüfung. Was ist zu tun?